LWN Medical PLLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

14326 Issued in AZ

Legal business name

LWN MEDICAL PLLC

Practice address

3401 Lockwood Dr
Lakeside, AZ 85929-5613

Phone

(928) 368-2060

NPI assigned

Aug 30, 2011

Last updated

Aug 30, 2011By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Larry W Nichols, MD

Title

Owner

Phone

(928) 537-7011

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1314662400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1314662400000",
    "number": "1073894598",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1600 S WHITE MOUNTAIN RD",
            "city": "SHOW LOW",
            "state": "AZ",
            "postal_code": "859017106",
            "telephone_number": "928-537-7011"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3401 LOCKWOOD DR",
            "city": "LAKESIDE",
            "state": "AZ",
            "postal_code": "859295613",
            "telephone_number": "928-368-2060"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LWN MEDICAL PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-08-30",
        "last_updated": "2011-08-30",
        "status": "A",
        "authorized_official_last_name": "NICHOLS",
        "authorized_official_first_name": "LARRY",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "928-537-7011",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "AZ",
            "license": "14326",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lakeside Medical PLLC
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• Marc Community Resources, Inc
• Mihaela N Marin, M.D.
• Nicolae Codrut Marin, LAC
• Bobette S Martin, M.A.,CCC-A
• Tyler Dillon McAvoy, RPH, PHARMD

• Skilled Nursing Facility in Lakeside, AZ
• Providers in Lakeside, AZ by specialty
• Skilled Nursing Facility in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.